CLINICAL RESEARCH: ASPIRIN, NON-STEROIDAL ANTI-INFLAMMATORY, AND CAD
Aspirin dose and six-month outcome after an acute coronary syndrome
Martin J. Quinn, MD, PhD*,
Herbert D. Aronow, MD, MPH ,
Robert M. Califf, MD, FACC ,
Deepak L. Bhatt, MD, FACC ,
Shelly Sapp, MS,
Neal S. Kleiman, MD, FACC||,
Robert A. Harrington, MD, FACC,
David F. Kong, MD, AM,
David E. Kandzari, MD and
Eric J. Topol, MD, FACC,*
* St. Vincents University Hospital, Dublin, Ireland
Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania and Philadelphia Veterans Administration Medical Center, Philadelphia, Pennsylvania, USA
Department of Cardiovascular Medicine, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
The Duke Clinical Research Institute, Durham, North Carolina, USA
|| Baylor College of Medicine, Houston, Texas, USA
Manuscript received July 9, 2003;
revised manuscript received September 12, 2003,
accepted September 29, 2003.
* Reprint requests and correspondence: Dr. Eric J. Topol, Department of Cardiovascular Medicine, Desk F 25, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio 44195, USA
topole{at}ccf.org
OBJECTIVES: This study was designed to compare the efficacy of low and intermediate aspirin doses in acute coronary syndromes.
BACKGROUND: Little is known of the comparative efficacy of low and intermediate aspirin doses in this setting.
METHODS: We compared six-month death, myocardial infarction (MI), and stroke in patients with unstable angina or acute MI discharged while receiving low (<150 mg) or intermediate ( 150 mg) aspirin therapy in the GUSTO IIb and PURSUIT trials (n = 20,521). We used multivariable analysis and performed a propensity analysis in order to adjust for baseline imbalances between the groups.
RESULTS: Aspirin doses <150 mg were prescribed to 29.9% (6,128) of patients. By six months, 6.4% of the patients (1,310 of 20,521) had a primary event, 6.2% of the patients receiving <150 mg and 6.6% of the patients receiving aspirin doses 150 mg (hazard ratio [HR] 1.06 [95% confidence interval (CI) 0.94 to 1.19], p = 0.35). After adjusting for baseline imbalances and the propensity score for discharge aspirin dose, there was no effect of aspirin dose on the composite end point at six months (HR 0.92 [95% CI 0.79 to 1.07], p = 0.28). However, the higher aspirin dose was associated with a reduction in six-month MI (HR 0.79 [95% CI 0.64 to 0.98], p = 0.03). The outcome was similar when patients were matched on the basis of the propensity score for aspirin dose (HR for death/MI/stroke 0.94 [95% CI 0.80 to 1.12], p = 0.51), although stroke occurred significantly more frequently among patients receiving the higher aspirin dose (HR 1.74 [95% CI 1.01 to 3.02] p = 0.05) and the effect on MI was no longer apparent.
CONCLUSIONS: Although these data are non-randomized, they suggest that the aspirin dose upon discharge may influence the clinical course after unstable angina or acute MI.
|
Abbreviations and Acronyms
| | ACS | = acute coronary syndrome | | ALDUSA | = Aspirin at Low Dose in Unstable Angina | | ATACS | = Antithrombotic therapy in Acute Coronary Syndromes Study Group | | CARS | = Coumadin Aspirin Reinfarction Study | | CHAMP | = Combination Hemotherapy and Mortality Prevention | | CI | = confidence interval | | DUCCS-II | = Duke University Clinical Cardiology Group Study-II | | ECG | = electrocardiographic | | GUSTO IIb | = Global Use of Strategies to open Occluded coronary Arteries | | HR | = hazard ratio | | MI | = myocardial infarction | | PURSUIT | = Platelet Glycoprotein IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrelin Therapy | | TxA2 | = thromboxane A2 |
|
This article has been cited by other articles:
|
|
|
|
 
S. R. Steinhubl, D. L. Bhatt, D. M. Brennan, G. Montalescot, G. J. Hankey, J. W. Eikelboom, P. B. Berger, E. J. Topol, and on behalf of the CHARISMA Investigators
Aspirin to Prevent Cardiovascular Disease: The Association of Aspirin Dose and Clopidogrel With Thrombosis and Bleeding
Ann Intern Med,
March 17, 2009;
150(6):
379 - 386.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. S. Berger, D. L. Brown, G. L. Burke, A. Oberman, J. B. Kostis, R. D. Langer, N. D. Wong, and S. Wassertheil-Smoller
Aspirin Use, Dose, and Clinical Outcomes in Postmenopausal Women With Stable Cardiovascular Disease: The Women's Health Initiative Observational Study
Circ Cardiovasc Qual Outcomes,
March 1, 2009;
2(2):
78 - 87.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. C. Austin
Primer on Statistical Interpretation or Methods Report Card on Propensity-Score Matching in the Cardiology Literature From 2004 to 2006: A Systematic Review
Circ Cardiovasc Qual Outcomes,
September 1, 2008;
1(1):
62 - 67.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. Krasopoulos, S. J Brister, W S. Beattie, and M. R Buchanan
Aspirin "resistance" and risk of cardiovascular morbidity: systematic review and meta-analysis
BMJ,
January 26, 2008;
336(7637):
195 - 198.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. L. Campbell, S. Smyth, G. Montalescot, and S. R. Steinhubl
Aspirin Dose for the Prevention of Cardiovascular Disease: A Systematic Review
JAMA,
May 9, 2007;
297(18):
2018 - 2024.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. O. Maree and D. J. Fitzgerald
Variable Platelet Response to Aspirin and Clopidogrel in Atherothrombotic Disease
Circulation,
April 24, 2007;
115(16):
2196 - 2207.
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. D. Michelson, A. L. Frelinger, and M. I. Furman
Resistance to antiplatelet drugs
Eur. Heart J. Suppl.,
October 1, 2006;
8(suppl_G):
G53 - G58.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. O. Maree, R. J. Curtin, M. Dooley, R. M. Conroy, P. Crean, D. Cox, and D. J. Fitzgerald
Platelet Response to Low-Dose Enteric-Coated Aspirin in Patients With Stable Cardiovascular Disease
J. Am. Coll. Cardiol.,
October 4, 2005;
46(7):
1258 - 1263.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. J. Mason, A. K. Jacobs, and J. E. Freedman
Aspirin Resistance and Atherothrombotic Disease
J. Am. Coll. Cardiol.,
September 20, 2005;
46(6):
986 - 993.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. P. Schulman
Antiplatelet Therapy in Non-ST-Segment Elevation Acute Coronary Syndromes
JAMA,
October 20, 2004;
292(15):
1875 - 1882.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
